Clinician Advisory

Travelers from Ebola-affected Countries

Requested actions

• Be aware that the Health District is currently monitoring travelers to Snohomish County from Guinea and the Democratic Republic of the Congo (DRC), where recent Ebola cases have been reported. 
• Notify the Health District at 425 339 3503 of any patient--sick or well--who presents to you having arrived from Guinea or DRC in the past 21 days. 

Local public health role

• Airlines are required to report to the Centers for Disease Control and Prevention (CDC) any traveler whose itinerary has included Guinea or DRC within 21 days prior to their arrival in the United States.  CDC then notifies state health departments who, in turn, delegate to local public health jurisdictions the follow-up and monitoring of these travelers upon arrival.
• Intensity and nature of follow-up over the 21-day incubation period depends on epidemiologic risk of the arriving traveler. All current arrivals known to us in Snohomish County (n<10) are low risk.   
• The Health District is in communication with our local assessment facility, Providence Regional Medical Center Everett. Suspected cases would either be admitted there or to Harborview Medical Center depending on their clinical presentation.  
• The most likely travelers to present who are unknown to the Health District would be those who entered the country, arrived at another destination, and then visited or relocated to Snohomish County without notifying the jurisdiction they left behind. 

Key clinical information

• Transmission: person-to-person through, blood, feces, other fluids
• Symptoms: fever, diarrhea, vomiting; may or may not be bleeding disorder (hemorrhage) or other complications
• Personal protective equipment: depends on patient presentation—see link for details

Background

• Beginning in early February 2021, Ebola cases have been reported from two geographically and epidemiologically distinct outbreaks in North Kivu Province (DRC) and N’Zerekore Prefecture (Guinea).   Sequencing of samples from affected patients suggests that the outbreaks have not been caused by spillover from an animal reservoir (i.e., bats) but rather by transmission from a persistent source of infection (i.e., survivors) from prior outbreaks.  
• Although both affected states are on international borders, investigations thus far have confirmed no cases outside these two countries.  One outbreak-related case also was diagnosed in Guinea’s capital city, Conakry (Ratoma region).  
• CDC is working with the affected countries, World Health Organization, and partners to implement response activities to stop the spread of the virus and end the outbreak.   Interventions include contact tracing, quarantine, and vaccination.  
• No new cases have been reported since March 6 in Guinea and since March 14 in DRC.   Outbreaks will be declared “over” when 42 days have passed since the last case.  
  

Additional resources

https://www.cdc.gov/vhf/ebola/clinicians/index.html

https://africacdc.org/disease-outbreak/outbreak-brief-5-ebola-virus-disease-evd-outbreak/ 

https://www.cdc.gov/vhf/ebola/outbreaks/drc/2021-february.html

https://www.cdc.gov/vhf/ebola/outbreaks/guinea/2021-february.html

https://www.who.int/csr/don/17-february-2021-ebola-gin/en/

https://www.who.int/csr/don/10-february-2021-ebola-drc/en/